Prevention of the neoplastic progression of Barrett's oesophagus by endoscopic argon beam plasma ablation

Background: Patients with Barrett's oesophagus have a risk of approximately 1 per 100 patient-years for the development of oesophageal adenocarcinoma. Endoscopic ablation of Barrett's oesophagus has been shown to lead to the regrowth of a 'neo' squamous epithelium if gastro-oesophageal reflux is con trolled, but the incidence of subsequent tumour formation is unknown. Methods: The follow-up of 55 patients who underwent endoscopic ablation of Barrett's oesophagus by argon beam plasma coagulation (ABPC) is reported. O f the 55 patients, nine had low-grade dysplasia, nine had high-grade dyspla sia and the remainder had non-dysplastic Barrett's metaplasia. Twelve patie nts had reflux control by antireflux surgery and the remainder received pro ton pump inhibitor therapy. Barrett's metaplasia was ablated by ABPC to wit hin 2 cm of the gastro-oesophageal junction. Results: To date, one patient has died and one patient was unable to comple te treatment. The remaining patients were followed by regular endoscopic su rveillance for a mean of 38.5 months to give a total follow-up of 173.5 pat ient-years. No malignancy has developed in any patient during follow-up. Conclusion: The absence of malignant complications in this study of prophyl actic ablation of long-segment Barrett's oesophagus strengthens the argumen t for endoscopic ablation in the prevention of oesophageal adenocarcinoma.